Ophthalmoscopic findings in sub-classification of the eighth joint national committee (JNC 8) hypertension in city of Karachi

Objective: To analyze the ophthalmoscopic findings in hypertensive patients in tertiary care hospitals of Karachi classified according to JNC 8 of hypertension. Materials and Methods: 1,100 cases were detected as hypertension as per JNC recommendations in outpatient departments of Liaquat National and Dow University Hospital from January 2017 to December 2017. Among them, 300 patients were selected according to inclusion criteria for ophthalmoscopy and four groups were made. Group-A comprised the white coat or masked hypertension. Group-B were incidental hypertensive, group-C included the known hypertensive on anti-hypertensive therapy and group-D were known hypertensive but not on anti-hypertensive therapy. Ophthalmoscopic findings were recorded in each group according to Keith Wagner's classification. The data were entered in SPSS for statistical analysis. Results: Out of 300 cases of hypertension, only 55/300 (18.3 percent) were found to have normal retina. In group-A which were labeled as white coat hypertensive 14 out of 17(82.5 percent) had normal retina, only 3 patients out of 17(5-66 percent) showed arteriolar narrowing. Group-B was classified as incidental hypertensive, 12 out of 32 (37.5 percent) had normal retina, while 20 out of 32(63 percent) showed arteriolar narrowing, only few patients had AV nipping or flame shaped hemorrhage or soft exudates in stage 1 and 2 stage hypertensive. In group-C 28 out of 108 (30 percent) had normal retina. Th e most consistent findings were arteriolar narrowing and AV nipping while hemorrhages, exudate and cotton wool spots was seen in less than 10 percent of cases. This showed the effect of control of hypertension on time by examining the retina. In group-D only one patient out of 143 had normal retina, while most ophthalmoscopic findings were hemorrhages and exudates with arteriolar narrowing and AV nipping. 5 patients had papilledema. This showed how non-compliant badly affects the retina. Conclusion: Hypertensive retinopathy is the most sensitive peripheral stigma as result of hypertension provided if ophthalmoscopy is done with correct methodology with dilated pupil. The ophthalmoscopic findings are justified with severity of hypertension as classified by JNC 8 in this study. (author)